脑星形细胞瘤的CT表现与血管生成的相关性研究

目的探讨脑星形细胞瘤的CT表现与其肿瘤血管生成的关系.材料和方法分析手术病理证实的82例脑星形细胞瘤的CT表现.采用免疫组织化学染色方法,染色血管内皮细胞第八因子相关抗原,标记微血管,然后测定微血管密度(MVD),并分析MVD与CT表现的相关性.结果星形细胞瘤的MVD越大,恶性程度越高,预后越差.星形细胞瘤CT密度的不均匀性、瘤周水肿、占位效应及增强程度与MVD明显相关,但星形细胞瘤的大小、部位与MVD无明显关系.结论星形细胞瘤的CT征象能反映星形细胞瘤的血管生成活性,术前分析星形细胞瘤的CT征象与MVD的关系,能更好的指导选择临床治疗方案和评估预后.     

过氧化物酶体增殖物激活受体γ在正常人脑和脑星形细胞瘤组织中的表达

目的探讨过氧化物酶体增殖物激活受体（PPAR）γ在正常人脑组织和人脑星形细胞瘤组织中表达的差异。方法应用半定量RT-PCR法和免疫组织化学检测正常脑组织、不同分化级别人脑星形细胞瘤组织标本中PPARγ表达。结果PPARγmRNA和PPARγ蛋白在正常人脑组织、人脑星形细胞瘤中均可表达,且人脑星形细胞瘤中的表达显著高于正常脑组织（P〈0．05）,其中,Ⅰ～Ⅱ级组和Ⅲ～Ⅳ级组的表达均显著高于正常脑组织（P〈0．05）;Ⅲ～Ⅳ级组的表达显著高于Ⅰ～Ⅱ级组（P〈0．05）。结论PPARγ在人脑星形细胞瘤和正常脑组织中均表达,与人脑星形细胞瘤的病理分级有关,可能参与人脑星形细胞瘤的发生、发展过程。     

Prognostic significance of astrocyte elevated gene-1 in human astrocytomas

Astrocyte Elevated Gene-1 (AEG-1) has been proposed as a biomarker for a variety of cancers. This study aimed to investigate the expression of AEG-1 in human astrocytomas and the correlation between AEG-1 expression and clinicopathologic variables of astrocytomas. AEG-1 expression in four pairs of matched astrocytomas tissues and 5 cell lines was detected by immunohistochemical and Western blot analysis. In addition, AEG-1 protein expression was examined by immunohistochemical staining in 204 cases, including 32 normal brain tissues, 80 Low-malignant astrocytomas (LMAs) and 92 High-Malignant astrocytomas (HMAs). AEG-1 expression in 31 LMAs and 29 HMAs samples was detected by RT-PCR and Western blot analysis. We detected AEG-1 expression in normal neurons and glioma cell lines U87, U251 and M059K, but not in normal glial cells. Immunohistochemical analysis showed that 128 of 172 (74.4%) paraffin-embedded archival astrocytomas samples exhibited positive AEG-1 expression. Statistical analysis suggested that higher AEG-1 level was significantly correlated with histological grade of astrocytomas. In addition, AEG-1 mRNA and protein expression was higher in HMAs than in LMAs. AEG-1 expression had no correlation with the gender or age of astrocytoma patients. In summary, our data suggest that AEG-1 may represent a novel prognostic marker for astrocytomas.     

胶质瘤失活蛋白在星形细胞瘤中的表达及临床意义

背景与目的：胶质瘤是最常见的恶性原发脑肿瘤，又以星形细胞瘤为最常见的胶质瘤。LGI1基因（1eucihe-rich glioma inactivated gene 1，LGI1）被发现在成神经胶质瘤细胞株上出现了基因重排现象，从而被认为是可以抑制肿瘤的候选基因，其结构和功能的异常将导致LGI1蛋白表达的缺失，可能是肿瘤细胞发生浸润转移和逃逸机体免疫监视的重要机制之一。本研究通过检测星形细胞瘤组织中胶质瘤失活蛋白的表达水平。探讨其与星形细胞瘤发生、发展、恶性程度及预后的关系。方法：应用免疫组织化学技术对50例星形细胞瘤患者肿瘤组织和12例来自于脑外伤内减压手术、高血压脑出血及脑血管畸形手术中所取的正常脑组织中LGI1蛋白的表达进行了检测。结果：肿瘤组与正常组LGI1蛋白阳性细胞百分率（0．283±0．271）vs（0．573±0．229）比较有显著性差异（P〈0．05）；低级别星形细胞瘤和高级别胶质瘤中LGI1蛋白阳性细胞百分率（0．383±0．279）vs（0．165±0．212）]比较有显著性差异（P〈0．05）。50例星形细胞瘤患者中肿瘤复发组与未复发组的LGI1蛋白表达阳性率（8/27vs18／23）比较有显著性差异（P〈0．05）；死亡组与未死亡组中的LGI1蛋白表达阳性率（4／21vs22／29）比较有显著性差异（P〈0．05）。50例星形细胞瘤患者中LGI1蛋白表达阳性组与表达阴性组GOS评分[（1．85±1．46）vs（3．92＋1．64）比较有显著性差异（P〈0．05）。结论：星形细胞瘤患者存在LGI1蛋白分子低表达，推测LGI1蛋白缺失率有可能成为预测脑胶质瘤恶性程度及预后的指标之一。     

术前癫痫与星型细胞瘤病理分级和预后的相关性分析

目的研究术前癫痫发生率与星型细胞瘤和预后的相关性，为临床治疗提供理论依据。方法收集1995年至2000年在青岛大学医学院附属医院神经外科治疗的47例星型细胞瘤患者的资料进行统计学分析。结果显示术前癫痫的发生率在不同生物学行为的星型细胞瘤问的差异有显著性（P〈0．01）；发生术前癫痫者的生存期与无癫痫者生存期差异也有显著性（P〈0．01）。结论术前癫痫在低侵袭性星型细胞瘤中发生率较高，并且对判断患者的预后有一定的意义。     

Ascending central nervous spreading of a spinal astrocytoma

A 43-year-old man died from the complications of astrocytoma metastasis. He first noticed symptoms of a lumbar disc prolapse in 1979. In 1987 a pilocytic astrocytoma (grade I) of the spinal cauda was removed. In 1989 a tumor recidivation at the same site was partially removed. Histology showed a grade II astrocytoma. Two months later the patient developed symptoms of increased intracerebral pressure. CSF cytology showed polymorphic giant tumor cells with hyperchromatic nuclei and a glioblastoma of the cerebral ventricles was diagnosed. The patient died from cardiovascular complications. The post-mortem investigation revealed an astrocytoma of the conus medullaris with an anaplastic ventral area (grade IV). This area was inaccessible to the biopsy. It is believed that tumor metastases from anaplastic parts spread along the spinal cord and brainstem and finally invaded the brain and cerebral ventricles.     

颅内星形细胞瘤术后生存期影响因素分析

本文通过对1975年4月～1992年7月间，经手术治疗并获随访的201例颅内星形细胞瘤，进行生存期影响因素分析。结果显示，Karnofsky评分、手术方式、术后治疗和病理分级作为单一影响因素时，对生存期的影响具有统计学意义；用Cox回归模型多因素分析显示，年龄、肿瘤部位、手术方式、术后治疗和病理分级，对生存期的影响具有统计学意义，尤以手术方式、术后治疗和病理分级与生存期的关系最为密切。本文结果提示，要获得满意疗效，必需基于手术全切基础，辅以有效术后冶方。     

Do Rosenthal fibers contain glial fibrillary acid protein?

Summary Sixteen cases of pilocytic astrocytomas with excessive Rosenthal fiber (RF) formation were examined by the indirect immunoperoxidase method for the localization of glial fibrillary acid protein (GFAP). RF nerve contained GFAP but they were often enclosed in plump and thickened GFAP-positive astrocytic processes. The border between the negative RF and the surrounding positive rim of cytoplasm was always sharp and without gradual transitions. The antigenic difference between RFs and glial filaments imply that glial filaments undergo a profound change in their chemical composition during their transformation into RFs. The possibility that RFs are not degradation products of glial filaments but consist of some chemically unknown substance produced by metabolically activated astrocytes cannot be excluded.     

Extracerebrale gliome im gesichtscbereich

Zusammenfassung Drei Fälle mit Gliomen im Gesichtsbereich werden geschildert und an Hand des vorliegenden Schrifttums die Pathogenese erörtert. Es handelt sich um Tumoren in der Stirnhöhle, am temporalen Augenunterlid und an der Retina. Alle Tumoren wurden vorweigend durch Astrocyten aufgebaut. Im Tumor des Augenunterlides wurden ferner markhaltige Nervenfasern und Ganglienzellen beobachtet. Da in den ersten beiden Fällen ein konnatales Auftreten angenommen werden konnte, wurde hier ein gleiches pathogenetisches Prinzip im Sinne einer frühembryonalen Encephalocelenbildung vermutet. Dabei muß sich neurogenes Gewebe abgespaltet haben. Nach der Geburt entwickelte sich ein blastomatöses Wachstum. Den Tumor der Stirnhöhle möchten wir den sogenannten nasalen Gliomen und den Tumor am Augenlid den sogenannten Retina-Anlage-Tumoren zuordnen. Bei dem von der Retina ausgehenden Gliom wird auf Grund des späten Manifestationsalters und der Tendenz zur Cystenbildung ein Tumor im Sinne eines cerebralen Astrocytoms vermutet.

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Extracerebral gliomas in the facial region

Summary Three cases of gliomas in the facial region have been presented and with a review of literature their pathogenesis was discussed. The tumors were localized in the sinus frontalis, the temporal lower eyelid, and in the vitreous body in connection with the retina. All tumors consisted mainly in astrocytes. In the tumor of the lower eyelid additional myelinated nerve fibres and nerve cells were seen. The first two cases probably were of connatal origin and therefore a common pathogenetic principle was suggested. We supposed an encephalocele-like herniation in the early fetal development. At the same time neurogenic tissue could have been separated. Postnatally, the tissue showed a blastomatous development. We include the tumor of the sinus frontalis in the nasal gliomas and the tumor of the lower eyelid in the retina-anlage-tumors. We suggested that the third tumor, which was fixed on the retina, was comparable with a cerebral astrocytoma because of the age of manifestation and the tendency to develop cysts.

Gewidmet Herrn Prof. Dr. B. Ostertag zum 75. Geburstag.     

The CSF-protein pattern in acute cerebellar ataxia of childhood and intracranial midline tumours

CSF-protein profiles of 25 children with acute cerebellar ataxia and of 39 children with intracranial midline tumours at diagnosis were examined by quantitative zone electrophoresis in agarose gel. The profiles were compared with those obtained from a control group of 86 cases, and those from 61 patients with aseptic meningitis and 40 children with bacterial meningitis. The data from the latter groups demonstrated the CSF-protein pattern of moderate or severe disturbance of the blood-CSF barrier (B-CSF-B), respectively. The children with acute cerebellar ataxia showed minor signs of a B-CSF-B impairment and no increase of -globulin. These findings point to a slight acute vascular lesion. CSF changes indicative of a moderate-to-severe dysfunction of the B-CSF-B occurred in the majority of the patients with cerebellar astrocytomas, pontine gliomas, tumours around the 3rd ventricle, and medulloblastomas. Therefore acute cerebellar ataxia can be differentiated from intracranial midline tumours in most cases by means of CSF-protein electrophoresis. A striking finding was that 12 out of 14 children with medulloblastomas revealed a marked increase of -globulin. Since in 5 of these cases oligoclonal -globulin could be detected, this finding means local immunoglobulin synthesis within the CNS. The marked increase of -globulin which almost exclusively occurred in association with medullo-blastomas allows their seperation from acute cerebellar ataxia and the other tumour groups. Quantitative agarose gel electrophoresis can be a complementary diagnostic test in children with acute ataxia and suspected of having a CNS infection, or in cases with a negative CT brain scan in which intracranial midline tumour is a likely possibility.